Successful empiric treatment of HSV hepatitis in pregnancy - Case report and review of the literature

Herpes simplex hepatitis (HSH) occurring in pregnant women must be differentiated from acute fatty liver of pregnancy (AFLP) and the HELLP syndrome (hemolysis, elevated liver function tests, and low platelets), two diseases which are relatively more common hepatic disorders unique to pregnancy (1). All three, however, are relatively unusual. In contrast to AFLP and the HELLP syndrome, a diagnosis of HSH must be made quickly, usually within 24 hr, as it is a rapidly progressive form of viral hepatitis which is associated with a very high mortality rate, particularly in pregnant women (2). Twenty-seven cases of HSH occurring during pregnancy have been reported in the English literature available to the authors of this report (3-22). The introduction of acyclovir into clinical medicine has changed the outcome of HSH occurring in pregnancy, such that survival is likely if the therapy is instituted early (2, 13, 15-20). Herein, we report a case of HSH diagnosed clinically, that was subsequently confirmed serologically and was treated successfully with acyclovir with survival of both the pregnant patient and her child.